Background and Summary of the Invention
This invention relates to uterine manipulators, and more particularly to a manipulator featuring an adjustable stop with is positionable against the cervix or outer end of the cervical canal by means accessible by the operator, i.e. located outwardly of the external opening of the vagina, with the manipulator inserted into the uterus.
A uterine manipulator is commonly used in properly positioning the uterus so that, for example, inaccessible areas may be viewed through a viewing scope passed through a small incision in the abdominal wall. A manipulator which includes an injector is usable in injecting fluids into the uterine cavity, a procedure followed, for instance, in determining fallopian tube patency by noting the flow of the injected fluid from the uterus and thence out of the fallopian tubes which are attached to the uterus.
One form of uterine manipulator which is known in the art is the one disclosed in U.S. Pat. No. 4,089,337. In the manipulator-injector disclosed in this patent, a disc or stop is provided which is biased by a spring to engage the cervix during manipulation of the uterus and which functions yieldably to hold an inflatable member against the junction of the uterine cavity with the inner end of the cervical canal. With this type of manipulator, it has been the practice to provide a preset collar or similar means which the spring reacts against when biasing the stop against the cervix.
Another form of manipulator is exemplified by the one disclosed in U.S. Pat. No. 4,430,076. In the manipulator of this patent, the stop which is positioned against the cervix or external opening of the cervical canal forms an integral part of an elongate handle which receives and firmly engages a catheter portion of the device.
In using manipulators of the above general description, and since the length of the cervical canal will vary from patient to patient, an operator will preset the adjustable components, i.e., the collar or the handle as the case may be, in an attempt thus to fit the manipulator for the particular patient involved The components are preset, since the construction of the manipulators is such that the components cannot be adjusted in position with the manipulators inserted inside the body. As an aid to making a proper setting, an operator typically might premeasure with a suitable measuring probe the combined distance of the length of the cervical canal and the length of the uterine cavity which joins with this canal. This procedure, however, produces only an approximation with respect to the optimum setting of the components, since the proportion of this measurement which makes up the length of the cervical canal will vary from patient to patient.
A general object of this invention is to provide an improved uterine manipulator featuring an adjustable stop for engaging the external opening of the cervical canal which may be adjusted by an operator externally of the vagina with the manipulator inserted into the uterus. The device permits accurate placement of the stop without the operator needing to determine the precise length of the cervical canal.
More specifically, the manipulator contemplated includes an adjustable clamp mechanism positioned remote from the insertable end of the manipulator and outside the external opening of the vagina with the manipulator inserted, and a compression and tension transmitting connector extending from the clamp mechanism to a stop provided for engagement with the external opening of the cervical canal.
In a specific and preferred embodiment of the manipulator, the clamp mechanism comprises opposed digitally operated members biased away from each other to produce a clamping position and movable toward each other under finger pressure for the purpose of releasing the clamp. The connector may take the form of a sheath encompassing a tubular portion of the manipulator which funnels or channels air to the inflatable member, the sheath having a nonclamping relationship with the tubular portion.
These and other objects and advantages are attained by the invention which will become more fully apparent from a reading of the following description to be taken in conjunction with the accompanying drawings.